Sudden unexplained infant death: the silent epidemic 

adorable ethnic infant sleeping on bed
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Your wings were ready, but my heart was not.” — Unknown

A word of caution: The following short, illustrative case may be triggering for some readers.

The story of Baby J

When Baby J was born, everyone who saw her knew that she was special. She was born a couple of weeks before her mother’s due date. She had some initial trouble with breastfeeding, which improved with the help of the lactation consultant, but otherwise, she did fine and was discharged home with her parents. 

She was a sweet baby who hardly ever seemed to cry. She was the first child for her parents, who loved her dearly. They had big hopes and dreams for their baby, but this all changed one horrible night in December. 

Her mom had fallen asleep next to her after breastfeeding her and woke up suddenly to find Baby J limp and unresponsive. Her lips were blue, and she was not breathing. She asked her husband to call 911 and started CPR. 

The paramedics arrived five minutes later and noted the baby was blue and still pulseless. They placed a breathing tube and used this to provide the baby oxygen and took over CPR. To give medications emergently, they inserted a needle into the bone below her knee through which they injected epinephrine to try to get her heart restarted. 

They continued CPR and placed Baby J in the ambulance with her mother while her husband followed in their car. When they arrived in the emergency department her parents watched as the doctors and nurses at the hospital continued CPR and gave more medicines as they worked to save their baby’s life. They also did x-rays and ultrasounds of her heart. 

The hospital staff worked on Baby J for over an hour but were not able to resuscitate her. Finally, the emergency room doctor came to tell her parents that despite their best efforts, Baby J had died. Her parents were devastated. Their hopes and dreams for their little angel were dashed and their lives would never be quite the same. 

Reducing the risks

Baby J’s death was one of the almost 3,500 deaths that occur every year from what is termed sudden unexplained infant death (SUID), or what many term sudden infant death syndrome (SIDS). SUID encompasses a group of disorders that include SIDS, ill-defined deaths, and accidental suffocation and strangulation in bed (ASSB). 

Deaths from SUID had decreased in the 1990s after a focused campaign by the American Academy of Pediatrics to promote safe sleeping practices. Many of the risk factors for SIDS and other sleep-related infant deaths are very similar. 

The American Academy of Pediatrics (AAP) has recommendations for a safe sleep environment that can reduce the risk of all sleep-related infant deaths. These include placing infants on their back to sleep, the use of a firm sleep surface, room-sharing without bed-sharing, and avoiding soft bedding and overheating. 

Other recommendations for SIDS reduction include the avoidance of exposure to cigarette smoke and the avoidance of alcohol and illicit drugs while caring for your baby. In addition, breastfeeding and routine immunizations and use of a pacifier also help to reduce the risk of SUID. 

Sadly, Native American and African American babies are disproportionately much more likely than White babies to die from SUID. There are multiple reasons for this, including cultural practices around how to put babies to sleep based on advice from relatives, or parental choices about sleep position, beddings, toys in the crib, and even whether to put the baby to sleep in a crib or bassinet or in bed with them. 

Even when in the crib or bassinet, some parents feel that the baby will be cold without multiple blankets or that the baby needs to have all kinds of toys around them. Babies should be put to sleep on their back, but many parents say that their babies prefer to sleep on their stomach.

Some parents choose to sleep in bed with their baby, and there are many reasons for this including parental concerns about the baby’s safety, or because they feel that their baby won’t fall asleep any other way. Some mothers may have just had a C-section and find it painful to constantly get in and out of bed. 

Sometimes parents are just too tired after long sleepless nights and find it easier to have the baby in bed with them for feeding and comfort. Unfortunately, this is very unsafe, and some parents have accidentally suffocated their babies by sharing the same bed with them.

It is also very important to contextualize reasons behind increased rates of SUID in Black and Indigenous populations. We must not lose sight of the connections with poverty and other adverse social determinants of health. Many of these are rooted in the systemic and environmental racism and the legacy of redlining in this country.

The ABCs of safe sleep

Infant safe sleep practices recommended by the American Academy of Pediatrics help reduce sleep-related infant deaths, but adherence to these recommendations remains inadequate. Many new parents may be unaware of these recommendations or of how significantly Black and Indigenous communities are impacted by SUID. 

There is a general lack of knowledge about how serious this issue of SUID is, because these devastating deaths rarely make the news. One is more likely to hear about a motor vehicle crash or firearm-related injuries or other injuries that are deemed more dramatic by the news media.

The lack of this media spotlight has truly made the deaths from SUID a silent epidemic. It is therefore incredibly important to spread the message about safe sleep guidelines. While many factors that lead to increased SUID rates in our community are difficult to solve overnight, the message about safe sleep is as simple as “ABC”. 

Your baby should sleep Alone, on their Back, and in a Crib (or bassinet) that has a firm surface and is free of toys, blankets or other objects that could cause suffocation. The AAP and CDC have additional resources.

AAP Safe Sleep: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

CDC Safe Sleep: https://www.cdc.gov/reproductivehealth/features/baby-safe-sleep/index.html

Dr. Andrew Kiragu is an associate professor of pediatrics at the University of Minnesota and the co-medical director of the Pediatric Brain Injury Program at Hennepin Healthcare in Minneapolis. He is an associate of the Children’s Respiratory and Critical Care Specialist’s group and provides pediatric critical care at Children’s of Minnesota and Gillette Children’s. He is a fellow of the American College of Critical Care Medicine and the American Academy of Pediatrics. Dr. Kiragu is also engaged in injury prevention efforts nationally and statewide. He serves on the boards of Safe Kids Minnesota, the Midwest Injury Prevention Alliance, and the Injury Free Coalition for Kids. Dr. Kiragu is also a strong advocate on behalf of Minnesota’s children and is a past president of the Minnesota Chapter of the American Academy of Pediatrics. He is also a past president of the Minnesota Association of African American Physicians.